阿托伐他汀对冠状动脉斑块退缩及其成分的影响

Effects of atorvastatin on recession of coronary plaque and its components

目的:应用血管内超声(intravascular ultra-sound,IVUS)传统灰阶成像及虚拟组织学(virtualhistology,VH)成像,评价中等剂量阿托伐他汀对冠状动脉斑块退缩及其成分的影响。方法:入选22例临床初诊为冠心病患者接受冠状动脉造影(coronary angiography,CAG)检查,患者至少有一支主要冠脉分支经冠脉造影目测狭窄程度在20%～50%,将其选做目标血管。造影后对目标血管行IVUS检查,记录灰阶及VH图像。所有入选患者在检查结束后给予20 mg阿托伐他汀(立普妥)治疗6个月,6个月后复查冠脉造影及IVUS。比较阿托伐他汀调脂治疗6个月前后低密度脂蛋白胆固醇(LDL-C)水平变化,同时通过定量冠脉造影(quantitative coronary angiography,QCA)分析目标血管段最小管腔直径(MLD)及直径狭窄率(DS)变化,通过血管内超声灰阶成像及VH成像分析斑块体积变化、斑块成分变化。结果:经过6个月治疗LDL-C水平明显降低,从(3.48±0.49)mmol/L降至(2.25±0.32)mmol/L,平均降低1.23 mmol/L,较基线值减少35.3%(P<0.05);斑块体积从(362±167)mm3降至(314±136)mm3,缩小48.2 mm3,较基线值减少13.3%,(P<0.05);纤维比例从66.7%±5.8%增至69.8%±4.4%(P<0.05),坏死核心比例从12.9%±5.8%减至9.8%±4.2%(P<0.05)。斑块体积退缩程度与LDL-C下降程度呈正相关(r=0.54,P<0.05),坏死核心比例减少与LDL-C下降程度无显著相关性(r=0.07,P>0.05)。结论:冠状动脉轻度病变患者通过中等剂量阿托伐他汀降脂治疗6个月可使斑块退缩并且增加斑块纤维比例、减少坏死核心比例,其中斑块退缩程度与LDL-C下降程度呈正相关。

AIM： To evaluate the effects of medium dosage atorvastatin on coronary plaque recession and its components using IVUS gray-scale and virtual histology analysis. METHODS： 22 patients who had been preliminarily clinically diagnosed as coronary heart disease were performed coronary angiography. The selected patients must have at least one major coronary branch whose stenosis extent was 20% - 50% by CAG examination with eye-measurement. The grayscale and virtual histology after selecting the stenosis aeteria coronaria as target vessel were recorded and the target blood vessel were examined by IVUS. All selected patients were treated with 20 mg atorvastatin lasting for 6 months after the performance and after 6 months the reexamination of the vessel by CAG and IVUS were performed. The LDL-C levels of patients before and after the treatment were compared; meanwhile the target vessel MLD and DS variation using quantitative coronary angiography were analyzed. The plaque volume and composition variation using IVUS were also analyzed. RESULTS： After 6 months, the LDL-C level was decreased significantly from （3.48 ± 0.49 ） mmol/L to （2.25 ± 0. 32） mmol/L. The mean decreasing level was 1.23 mmol/L and the level diminished 35.3 % （ P 〈 0. 05） compared with the baseline. The volume of plaque was decreased from （362 ± 167） mm^3 to （314 ± 136） mm^3. It was decreased by 48.2 mm3 and compared with the baseline it diminished 13.3% （P 〈 0.05 ）. The proportion of fiber was increased from 66.7% ＋ 5.8% to 69.8% ± 4.4% （P 〈 0.05）, and the proportion of necrosis core was decreased from 12.9% ±5.8% to9.8% ±4.2% （P〈 0.05）. The decreasing level of plaque volume was related to the LDL-C decreasing level（ r = 0.54, P 〈 0.05）, also the proportion of necrosis core decreasing level was related to the LDL-C decreasing level （ r = 0.07, P 〉 0.05 ）. CONCLUSION： Patients with mild coronary artery lesions were treated with medium dosage of atorvastatin for 6 months, the plaque recessed, the proportion of fiber increased and the proportion of necrosis core decreased, moreover, the plaque volume decreasing level was related to the LDL-C decreasing level.